Errors in ‘BED’-Derived Estimates of HIV Incidence Will Vary by Place, Time and Age 英文参考文献.docVIP

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Errors in ‘BED’-Derived Estimates of HIV Incidence Will Vary by Place, Time and Age 英文参考文献.doc

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Errors in ‘BED’-Derived Estimates of HIV Incidence Will Vary by Place, Time and Age 英文参考文献

Errorsin‘BED’-DerivedEstimatesofHIVIncidenceWill VarybyPlace,TimeandAge TimothyB.Hallett1*,PeterGhys2,TillBa¨rnighausen3,PingYan4,GeoffP.Garnett1 1Imperial College London, London, United Kingdom, 2Joint United Nations Programme on AIDS (UNAIDS), Geneva, Switzerland, 3Africa Centre for Health and PopulationStudies,UniversityofKwaZulu-Natal,Durban,SouthAfrica,4PublicHealthAgencyofCanada,Ottawa,Canada Abstract Background: The BED Capture Enzyme Immunoassay, believed to distinguish recent HIV infections, is being used to estimateHIVincidence,althoughanimportantpropertyofthetest–howspecificitychangeswithtimesinceinfection–has notbeennotmeasured. Methods:WeconstructhypotheticalscenariosfortheperformanceofBEDtest,consistentwithcurrentknowledge,andexplore howthiscouldinfluenceerrorsinBEDestimatesofincidenceusingamathematicalmodelofsixAfricancountries.Themodelis alsousedtodeterminetheconditionsandthesamplesizesrequiredfortheBEDtesttoreliablydetecttrendsinHIVincidence. Results:IfthechanceofmisclassificationbyBEDincreaseswithtimesinceinfection,theoverallproportionofindividuals misclassified could vary widely between countries, over time, and across age-groups, in a manner determined by the historiccourseoftheepidemicandtheage-patternofincidence.Undersomecircumstances,changesinBEDestimatesover timecanapproximatelytrackactualchangesinincidence,butlargesamplesizes(50,000+)willberequiredforrecorded changestobestatisticallysignificant. Conclusions:TherelationshipbetweenBEDtestspecificityandtimesinceinfectionhasnotbeenfullymeasured,but,ifit decreases,errorsinestimatesofincidencecouldvarybyplace,timeandage-group.Thismeansthatpost-assayadjustment proceduresusingparametersfromdifferentpopulationsoratdifferenttimesmaynotbevalid.Furtherresearchisurgently neededintothepropertiesoftheBEDtest,andtherateofmisclassificationinawiderangeofpopulations. Citation:HallettTB,GhysP,Ba¨rnighausen T,YanP,GarnettGP(2009)Errorsin‘BED’-DerivedEstimatesofHIVIncidenceWillVarybyPlace,TimeandAge.PLoS ONE4